The burden of misclassification of antepartum stillbirth in Nepal

Gurung, Rejina; Litorp, Helena; Berkelhamer, Sara; Zhou, Hong; Tinkari, Bhim Singh; Paudel, Prajwal; Malla, Honey; Sharma, Srijana; Kc, Ashish

doi:10.1136/bmjgh-2019-001936

Cited by 6 publications

(6 citation statements)

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“…In Nepal, like many other settings, caste and ethnicity are key determinants of social hierarchy and access to care [36]. Families from higher castes and relatively advantaged ethnic groups are more likely to receive higher quality of care [34,53], and have more access to facility birth [54,55]. Qualitative data to exploring these differences would be helpful to better understand if findings are related to local normative values and potential issues of stigmatisation, or data collection methods.…”

Section: Discussionmentioning

confidence: 99%

Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

Gurung

Ruysen

Sunny

et al. 2021

BMC Pregnancy Childbirth

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Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = − 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01–0.05) of receiving skin-to-skin contact than those with vaginal births. Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

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Section: Discussionmentioning

confidence: 99%

Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

Gurung

Ruysen

Sunny

et al. 2021

BMC Pregnancy Childbirth

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“…The majority (> 84%) of stillbirths are in low-and middle-income countries (LMICs) and an estimated 50% are intrapartum [4,5]. Resuscitation is recommended for all babies who do not breathe after birth since live births may be misclassified as stillbirths [6,7]. Meeting Sustainable Development Goal (SDG) targets by 2030 for ending preventable neonatal deaths requires universal coverage of high quality care around birth for women and their babies, including resuscitation for those who do not breathe at birth [8,9].…”

Section: Introductionmentioning

confidence: 99%

Neonatal resuscitation: EN-BIRTH multi-country validation study

Peven

Ameen

et al. 2021

BMC Pregnancy Childbirth

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Background Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage. Methods The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017–2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation. Results Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5–40.8%, specificity 66.8–99.5%), BMV accuracy was higher (sensitivity 12.4–48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure. Conclusions Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.

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“…Hypertensive disorders in pregnancy were the most common. 7,9,21 In our study, most of the stillborn babies (88.9%) were delivered with normal vaginal delivery. Vaginal delivery was the main mode of delivery also in other studies (94.9%, 77.5% and 86.2% and 94.9%).…”

Section: Discussionmentioning

confidence: 54%

“…2 The incidence was found to be 15 and 11.2 per 1000 births studied conducted in Nepal. [6][7][8][9] Similarly, the incidence of stillbirth was 16 per 1000 births in a study conducted in Sudan. 10 The incidence of IUFD in Nepal was observed as low as 8 per 1000 births in one study.…”

Section: Discussionmentioning

confidence: 99%

Stillbirths among Pregnant Women Admitted to Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Khadka¹,

Dhakal²,

Dhakal³

et al. 2022

J Nepal Med Assoc

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Introduction: Stillbirth is often defined as the death of a foetus in the uterus prior to its birth or during the process of birth. Most of the stillbirths are preventable global health problem. The aim of this study was to find out the prevalence of stillbirths among pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care centre among pregnant women admitted between 14 April 2021 to 13 April 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 43). Convenience sampling method was used. The data was collected from the medical record section using a proforma. Point estimate and 95% Confidence Interval were calculated. Results: Among 5118 pregnant women, stillbirths were found in 126 (2.46%) (2.04-2.88, 95% Confidence Interval). Conclusions: The prevalence of stillbirth among pregnant women was higher than in the other studies done in similar settings.

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The burden of misclassification of antepartum stillbirth in Nepal

Cited by 6 publications

References 25 publications

Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

Neonatal resuscitation: EN-BIRTH multi-country validation study

Stillbirths among Pregnant Women Admitted to Department of Obstetrics in a Tertiary Care Centre: A Descriptive Cross-sectional Study

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